Clinical Application Value Of The Three-dimensional Reconstruction About The Multislice Spiral Computed Tomography Angiography In Preoperative Evaluation Of Spinal Tumors And Vascular Lesions

Objective:This study attempts to compare the three-dimensional 64-slice spiral CT reconstruction with conventional imaging modality in spinal tumors and vascular lesions, and also to assess the usefulness of 3D-MSCTA and reconstruction techniques in diagnosis and preoperative evaluation of neurological disease through mimicing fenestration and operative approach with bone-cut techniques. Methods: The original enhanced axial CT images were performed by 64-slice spiral CT which produced by GE.After all data was entered into computer workstation and suitable threshold of reconstruction was selected, the 3D reconstruction were performed through the use of GE’s AW 4.3 software. The technique of volume rendering (VR), multiplanner reconstraction (MPR), shade surface display(SSD), max intensity projection (MIP) were used to reconstruct the 3D images in all cases and simulate the approach of operation, then the bone, turmor and vessel images were obtained. With pseudo-color technique,the authors viewed the lesion using different rotation and measured distance, angle and volume, and for those who need operation the authors imitated fenestration and designed the best operative approach with bone-cut techniques. The operating surgeon commented on the relative accuracy of the impression he got from the 3D reconstruction images compared with conventional displays and evaluated the operative approach for the patients undergoing operation. This paper reported 29 cases with typical heurological diseases, including 26 cases of spinal tumors and 3 cases of intraspinal vascular diseases. Result:Except two cases of lipoma and one case of ependymoma, the other tumors all have different levels of enhanced staining in the total 26 cases of spinal tumor patients. Among the patients,9 spinal tumors with rich blood supply in 3D images, demonstrated clearly the tumor origination, the ivasion to the bone, the supplying artery and the relationship between the tumors and the involving vessels. While it was not so clear in those tumors that were not well enhanced. The 3D images of 2 intraspinal AVMs also provided the spatial relationship among supplying artery, malformation vessels and draining veln.The 3D-MSCTA showed negtive result in 1 AVM, while the MRI couldn’t find any abnormality either. However, after the surgical removal of hematoma exploration found abnormal small blood vessels.10 patients imaging showed the spinal sclerotin eroded and destructed by the tumor and also the hyperplastic edge of vertebral cortical.Imaging of 5 patients showed changes of spinal curvature, scoliosis or kyphosis deformity. Except 1 patient changed the original plan of a second operation to onestage operation, the imaging were right in accordance with what we saw in operation. Conclusions:3D-MSCTA simplifies the course of viewer’s thought and vividly demonstrates the size, shape, location and spatial relationships of the tumors.The major advantage of 3D-MSCTA is simple, rapid, noninvasive, reliable.It is very useful for the diagnosis of intraspinal vascular lesions especially such as vascular malformation.It can also provide necessary information for surgical planning and decrease surgical complications.For the vast majority of patients, it can make up the information for MRI, it will be one of the most important instruments for preoperation evaluation.